MEDICARE: JOHN A ICETON MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	H6857	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H6857	OTHER		MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689842445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A ICETON MD PA

Provider Business Mailing Address
First Line	:	2927 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-983-5178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2927 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-983-5178
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. JOHN A ICETON
Credential	:
Telephone Number	:	409-983-5178

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	03/07/2023

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Directions to “JOHN A ICETON MD PA ” Practice Location

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